Cystic Areas Research Articles

Afferent Renal Nerve Activity is Proportionately Increased with Cystic Progression in a Preclinical Model of Autosomal Recessive Polycystic Kidney Disease

Polycystic kidney disease (PKD) is the most common genetic cause of kidney failure, though the mechanisms underlying cyst formation and disease progression remain unclear. Innervation of the kidney contributes to the pathology of other cardiorenal dysfunction, including hypertension and chronic kidney disease ‐ frequent complications of PKD. In previous studies, we demonstrated renal denervation (RDNX), either total or afferent‐targeted (sensory) nerve ablation, reduced cystogenesis in a rat model of autosomal recessive PKD, thus highlighting a role for renal afferent nerves in PKD renal cystogenesis. To further elucidate this novel relationship, we aimed to quantify the renal afferent nerve activity (ARNA) in the adult PCK rat compared to non‐cystic controls. We hypothesized that ARNA would be elevated in the PCK rat compared to controls, and ARNA would directly correlate with renal cystic severity.To address our hypothesis, we conducted direct afferent renal nerve recordings in 10‐week‐old PCK (n=15; 11M/4F) and age‐matched Sprague‐Dawley controls (SD; n=14; 6M/8F). Multiunit nerve recording was performed under isoflurane anesthesia by isolating and placing a renal nerve bundle on an iridium bipolar electrode, which was then encased in silicone. The nerve bundle was severed proximal to the electrode to isolate afferent renal nerve activity (ARNA). Following a 10‐minute stabilization period, resting ARNA was recorded for 10 minutes. To permit comparison between animals, resting ARNA was normalized to a maximal stimulus, achieved by renal pelvic perfusion of 50 µM capsaicin. Finally, electrical noise was isolated by sectioning the distal end of the nerve bundle. Recordings were rectified and integrated over 50 ms. ARNA was expressed as a percentage of maximal ARNA. Following nerve recording, kidneys were collected, formalin fixed, and embedded in paraffin for histologic analysis of renal cystic index (CI). Kidneys were stained with Masson’s Trichrome and analyzed using ImageJ, and CI was quantified by normalizing cystic area to the total kidney area. Data presented as mean ±SEM.Resting ARNA was higher in PCK (22.7±4.2%) rats compared to non‐cystic SD controls (7.4±1.3%; Figure 1). Overall, PCK rats had an average CI of 8.7±0.7%. No sex differences in ARNA between male and female PCK rats were detected; however, CI was higher in male PCK rats (9.5±2.3%) compared to female PCK (6.3±1.9%). Further analysis of ARNA versus cystic index revealed a direct correlation between ARNA and renal cystic severity (F=5.9; R=0.61; p<0.05; Figure 2).These findings support our hypothesis that ARNA is elevated in the PCK rat. Importantly, ARNA is directly correlated with cystic progression in this model. To our knowledge, this study is the first to directly measure ARNA in this model of ARPKD, as well as to compare ARNA to cyst severity. These findings, combined with our previous studies, lead us to conclude that increased ARNA may directly contribute to the progression of PKD in this model. Presently, these data are limited to single endpoint observations. We are currently conducting additional studies to further dissect the temporal relationship between ARNA and renal cyst development. Our future studies will investigate the stimuli amplifying ARNA in a continued effort to parse the role of this novel neural‐renal axis in the pathogenesis of PKD.

Ultrasonographic features and clinical pathological of liver metastasis in patients with melanoma

Objective: To investigate the ultrasonographic features and clinical pathological of liver metastasis in patients with melanoma. Methods: Thirteen patients with liver metastasis from melanoma treated in Tianjin Medical University Cancer Institute and Hospital from 2013 to 2019 were selected, and their ultrasonographic and clinicopathological characteristics were analyzed retrospectively. Results: Eleven of the 13 patients had multiple liver lesions. The maximum diameter of the lesions was (5.89±2.73) cm. Five cases of lesions were mixed echo (3 cases with high melanin content), 4 cases of lesions were hyperechoic (3 cases with low melanin content), 3 cases of lesions were hypoechoic (all with high melanin content), 1 case of lesions were equal echo (with high melanin content). The lesions in 11 patients had clear boundaries, while other 2 patients lacked the clear borders. Cystic areas were present in the lesions of 3 patients. Six cases had irregular lesions (lobulated), and 7 cases had regular lesions (round, oval). There were acoustic halos around the lesion in 9 cases and smooth and uneven acoustic halos in 5 cases. The results of immunohistochemistry showed that 11 cases were positive for S-100, HMB45 and Melan-A. One patient was not tested for HMB45, while S-100 and Melan-A were positive. One patient did not undergo Melan-A test, while S-100 and HMB45 were positive. Conclusion: Most of the liver metastases of melanoma are mixed echo or hyperechoic, most of them are nodular with clear boundaries combined with vocal halo, and a few of the lesions have cystic areas.

PERIPHERAL KERATOAMELOBLASTOMA/SOLID KERATOCYSTIC ODONTOGENIC TUMOR

<h3>Introduction</h3> Keratoameloblastoma (KAB) is considered a rare variant of ameloblastoma (AMEL). Three histomorphologic types exist: a) simple (acanthomatous ameloblastoma), b) complex with features of both AMEL and keratocyst odontogenic tumor (KOT/OKC), and c) papilliferous revealing papillary keratin-containing extensions in cystic ameloblastomatous lumina. There are two opposing theories on the development of KAB; 1) the tumor arises de novo as an ameloblastoma with exuberant keratin production, and 2) ameloblastomatous transformation occurs in preexisting KOT/OKC. Rare reports exist of solid KOT/OKC (SKOT) sharing features with KAB suggesting a hybrid lesion. Recently, it has been suggested that KAB should be reclassified as SKOT based on the presence of <i>ptch1</i>variants. Herein, we present a peripheral odontogenic tumor with features of KAB and SKOT. <h3>Materials and Methods</h3> 54-year-old male presented with a firm tender swelling of the right side of maxilla in the area of the premolars causing saucerization of the alveolar bone. <h3>Results</h3> Originating from surface epithelium, the tumor exhibited plexiform, follicular and cystic growth patterns with features encountered in KOT/OKC and stellate reticulum areas and reverse polarization in the periphery. Foci of mild pleomorphism and a few scattered mitoses were noted. Plexiform and cystic areas featured abundant keratin. Elongated lingulae infiltrating the connective tissue as well as plexiform extensions with predominantly ameloblastomatous features and few areas of keratinization were appreciated on the surface epithelium. The stroma revealed plasmacytic inflammation and multiple calcifications representing calcifying keratin deriving from burst cysts. Cytokeratin 19 plasmalemmal staining was observed. Keratin in calcifications was also stained. Ber-EP4 revealed focal plasmalemmal reaction in the surface epithelium with ameloblastomatous changes. There was no staining for calretinin and BRAF V600E. Variable Ki67 nuclear staining was noted. <h3>Conclusions</h3> Features of KAB and SKOT were observed. Next generation sequencing for the presence of <i>braf</i> or <i>ptch1</i> variants is underway.

Osseous sarcoidosis with fingers distal phalanx autoamputation in a treatment-naïve case

We report a case of a 55-year-old female, with 3 years history of a treatment-naive sarcoidosis involving lungs with second-stage sarcoidosis, skin in form of lupus pernio, and bones with multiple cystic areas of the digital bones, soft tissue swelling, nails dystrophy and missed phalanges. Uveitis frequently associated with bone sarcoidosis, was absent in our patient. Prior to attend to our clinic, she had been treated with short courses of nonsteroidal anti-inflammatory drugs and analgesics. No long-term corticosteroids therapy had been reported. Osseous lesions led to autoamputation of distal phalanges of two fingers. It is a very rare complication of unclear mechanism; however, they have been attributed by Several authors to long-term corticosteroid therapy, hypothesis not supported by our findings. Systemic corticosteroids are considered as standard medication. There are no firm guidelines for dosage and period of the treatment. Steroidsparing agents are often added mainly methotrexate, in some patients, biologics can be considered. Unfortunately for our patient, there was not enough time for management as she died lately

Application of high-frequency ultrasound in detection and identification of nasal filling injection materials.

To access and determine the ultrasound images of different nasal filling injection materials. From November 2014 to November 2021, facial ultrasound images of Plastic Surgery Hospital of Chinese Academy of Medical Science were analyzed and judged. A total of 337 cases were enrolled, including 203 cases of hyaluronic acid, 102 cases of polyacrylamide hydrogel, 16 cases of calcium hydroxyapatite-based fillers, 10 cases of silicone oil, and 6 cases of growth factor. According to ultrasound images, hyaluronic acid is characterized by anechoic area with a clear boundary, which seems like a capsule, and the internal echo is uniform, there is no obvious blood flow signal in it. It is possible to see a stratified appearance if hyaluronic acid diffused into surrounding tissues, and it is mainly exhibited as hypoechoic area, with anechoic or hypoechoic areas in it. Polyacrylamide hydrogel showed irregular flocculent hypoechoic or fine punctured hypoechoic under ultrasound, which could aggregate into cystic hypoechoic area or disperse in tissue space, and echo floating or dislocation flow could be seen under probe pressure. Under ultrasound, calcium hydroxyapatite-based filler is characterized by heterogeneous hyperechoic or hypoechoic area, which spreads in the tissue space with unclear boundary with surrounding tissue, and no obvious liquid flow could be observed. Silicone oil is commonly found in the dermis, it is characterized by cloud-like high echo, the deep tissue is not clear. Growth factor is characterized by heterogeneous echo, which is similar to the echo of peripheral tissue, and the boundary is not clear. Plenty of blood flow signals suggest infection. If the image is characterized with posterior echogenic shadow, it suggests calcification. High-frequency ultrasound can identify the types of nasal filling injection materials and can guide the selection of clinical treatment plan according to the classification of imaging features.

Cervical lymphangioma with myxoid degeneration: a rare case report and literature review

BackgroundLymphangioma is a multi-systemic disease mostly affecting the mesentery, omentum, mesocolon and retroperitoneum and rarely involving bone, with fewer than 30 cases reported so far. Lymphangioma usually has no specific clinical manifestation and could be easily misdiagnosed. Lymphangioma with myxoid degeneration was not reported. We report a histopathologically proved case of lymphangioma of 6th and 7th cervical vertebra (C6–7) with myxoid degeneration.Case presentationA 45-year-old male who suffered from pain in the right shoulder for 1 month, aggravated with numbness in the right little finger and ring finger and radiating pain for half a month. CT showed multiple cystic bone destruction areas in C6–7 vertebral right part and appendage with marginal osteosclerosis and surrounded by soft tissue density. The size of the lesion was about 36 mm × 41 mm . MRI: the margin of the lesion appears lobulated. Lesion showed slightly hypointense on T1WI, slightly hyperintense on T2WI and STIR. Multiple patchy T1WI hypointense and T2WI hyperintense shadows were seen within the lesion. No enhancement was observed in the lesion after injection of contrast, and there was no abnormal signal in surrounding soft tissue and bone. The histopathological examination confirmed the diagnosis of lymphangioma with myxoid degeneration after surgical resection. After over 2 years of follow-up, there were no signs of disease recurrence and progression.ConclusionsTo the best of our knowledge, this is the first case reported in English language literature of lymphangioma with myxoid degeneration.

Cystic Endometrial Hyperplasia in a Domestic Rabbit (Oryctolagus cuniculus domesticus)

Background: Cystic endometrial hyperplasia is a hormone-dependent disease induced by systemic increase in progesterone that can occur in several domestic species, such as the rabbit. This disease may be associated with sex steroid hormones, especially progesterone, and may be asymptomatic, and it is diagnosed using complementary imaging tests such as total abdominal ultrasound. However, surgical excisional biopsy with histopathological tissue analysis is the gold standard. This study reports a case of asymptomatic cystic endometrial hyperplasia in a female Miniature Lion Lop rabbit (Oryctolagus cuniculus domesticus) treated with therapeutic ovariohysterectomy.Case: A domestic, adult, female Miniature Lion Lop rabbit (Oryctolagus cuniculus domesticus), aged approximately 5 years and weighing 3.2 kg, was referred to specialized care to undergo ovariohysterectomy, an elective procedure. The tutor only reported the occurrence of a single episode of vulvar secretion more than 2 years ago, treated with antibiotics, with remission of clinical signs. In the intraoperative period after celiotomy, the uterine horn and uterine body showed a significant increase in volume, with abnormal color changes and tissue consistency; however, both changes were clinically asymptomatic. Subsequently, biopsy was performed during the ovariohysterectomy procedure. The excised uterus and ovaries were placed in 10% formalin and histopathologically analyzed. The macroscopic histopathological examination of the sectioned tissue revealed a slight amount of brownish fluid inside the uterine horns, in addition to multiple cystic areas in the uterine mucosa. Microscopic examination revealed marked hyperplasia of well-differentiated endometrial epithelial cells, occasionally forming cystic structures of different sizes. Moderate congestion, mild multifocal hemorrhage, and mild multifocal inflammatory infiltrate in the lamina comprising lymphocytes and plasma cells were also observed. Therefore, a diagnosis of cystic endometrial hyperplasia with mild lymphoplasmacytic endometritis was made. Observation of the patient was recommended without therapeutic indication.Discussion: Although the pathogenesis of cystic endometrial hyperplasia remains unknown, it is suggested that it is associated with the presence of sex steroids. Hence, this is a common disease in female rabbits, as they have non-seasonal polyestrous cycles and induced ovulation. Cystic endometrial hyperplasia may be asymptomatic or subclinical, without any significant clinical signs. Conversely, when associated with an infection such as pyometritis, the clinical signs include intermittent hematuria, anemia, lethargy, anorexia, and tenderness in the uterus on palpation. Although diagnosis can be made using total abdominal ultrasound and radiography, it can only be confirmed by the histopathological evaluation of the biopsied uterine tissue. Histopathological features of this disease include endometrial thickening with irregular glandular cystic elevations and hyperplasia of the pseudostratified cylindrical ciliated cells of the uterine glands. Furthermore, lymphoplasmacytic infiltrate is found in the uterine tissue, demonstrating an inflammatory reaction or bacterial infection concomitant with endometrial hyperplasia. In this case, the treatment of choice was therapeutic ovariohysterectomy, which is considered curative in this disease. Thus, ovariohysterectomy can resolve cystic endometrial hyperplasia in a domestic female Miniature Lion Lop rabbit.Keywords: surgery, ovariohysterectomy, rabbits, wildlife.Título: Hiperplasia endometrial cística em coelho-doméstico (Oryctolagus cuniculus domesticus)Descritores: cirurgia, ovariosalpingohisterectomia, coelhos, animais selvagens.

Pinostrobin inhibits renal CFTR-mediated Cl− secretion and retards cyst growth in cell-derived cyst and polycystic kidney disease rats

Cystic fibrosis transmembrane conductance regulator (CFTR) plays crucial role in renal cyst expansion via increase in fluid accumulation. Inhibition of CFTR has been proposed to retard cyst development and enlargement in polycystic kidney disease (PKD). Pinostrobin, a bioactive natural flavonoid, possesses several pharmacological effects. The present study investigated pharmacological effects of pinostrobin on CFTR-mediated Cl− secretion and renal cyst expansion in in vitro and in vivo models. Pinostrobin (10 and 50 μM) reduced number of MDCK cell-derived cyst colonies and inhibited cyst expansion via inhibition of cell proliferation and CFTR-mediated Cl− secretion. The inhibitory effect of pinostrobin was not due to the decrease in cell viability and activity of Na+-K+-ATPase. We also investigated the natural analogue pinocembrin as well as the synthetic analogue pinostrobin oxime. Both pinocembrin and pinostrobin oxime did not reduce CFTR-mediated Cl− secretion. In PKD rats, oral administration of pinostrobin (40 mg/kg/day) exhibited a decreasing in cystic area compared to vehicle-treated rats. Pinostrobin treatment inhibited renal expression of CFTR protein in PKD rats. Our findings highlighted the potential therapeutic application of pinostrobin in PKD.

Non-Invasive Monitoring of Increased Fibrotic Tissue and Hyaluronan Deposition in the Tumor Microenvironment in the Advanced Stages of Pancreatic Ductal Adenocarcinoma.

Pancreatic ductal adenocarcinomas are characterized by a complex and robust tumor microenvironment (TME) consisting of fibrotic tissue, excessive levels of hyaluronan (HA), and immune cells. We utilized quantitative multi-parametric magnetic resonance imaging (mp-MRI) methods at 14 Tesla in a genetically engineered KPC (KrasLSL-G12D/+, Trp53LSL-R172H/+, Cre) mouse model to assess the complex TME in advanced stages of tumor development. The whole tumor, excluding cystic areas, was selected as the region of interest for data analysis and subsequent statistical analysis. Pearson correlation was used for statistical inference. There was a significant correlation between tumor volume and T2 (r = -0.66), magnetization transfer ratio (MTR) (r = 0.60), apparent diffusion coefficient (ADC) (r = 0.48), and Glycosaminoglycan-chemical exchange saturation transfer (GagCEST) (r = 0.51). A subset of mice was randomly selected for histological analysis. There were positive correlations between tumor volume and fibrosis (0.92), and HA (r = 0.76); GagCEST and HA (r = 0.81); and MTR and CD31 (r = 0.48). We found a negative correlation between ADC low-b (perfusion) and Ki67 (r = -0.82). Strong correlations between mp-MRI and histology results suggest that mp-MRI can be used as a non-invasive tool to monitor the tumor microenvironment.

Warthin like Variant of Papillary Thyroid Carcinoma: A Rare Variant

Introduction: Warthin like papillary thyroid carcinoma is a rare variant that bears features similar to Warthin tumour of salivary gland. It shows papillary or follicular structures lined by oncocytic cells having typical nuclear features of papillary thyroid carcinoma and marked lymphoplasmacytic infiltrate in the stroma. Case Report: A 60 year old lady presented in the ENT OPD with right sided neck swelling since 2 years. On examination the swelling was firm, non-tender, moving with deglutition and measured 4x3 cm. FNA smears of the swelling were highly cellular and comprised of cells arranged in papillary clusters. The cells were predominantly oncocytic and showed nuclear grooving and intranuclear inclusions. Cytological diagnosis of papillary thyroid carcinoma (Bethesda Category VI) was offered. Thyroidectomy specimen measured 6.5x5x3 cm and right lobe revealed gray tan tumor with numerous papillae and few cystic areas. Microscopy revealed a well circumscribed tumour, with tumour cells arranged in papillary architecture with presence of dense lymphoplasmacytic infiltrate in the stalks of papillae. The cells lining the papillae had abundant granular eosinophilic cytoplasm and many of the cells showed nuclear grooving and intranuclear inclusions. Occasional psammoma bodies were also seen. The surrounding thyroid showed features of hashimoto’s thyroiditis. A final diagnosis of Warthin like variant of papillary thyroid carcinoma was given. Conclusion: Warthin like variant of papillary thyroid carcinoma is a distinct rare variant. It is associated with good prognosis when compared with other variants of papillary thyroid carcinoma, warranting a proper identification.

Directional analysis of intensity changes for determining the existence of cyst in optical coherence tomography images

Diabetic retinopathy (DR) is an important cause of blindness in people with the long history of diabetes. DR is caused due to the damage to blood vessels in the retina. One of the most important manifestations of DR is the formation of fluid-filled regions between retinal layers. The evaluation of stage and transcribed drugs can be possible through the analysis of retinal Optical Coherence Tomography (OCT) images. Therefore, the detection of cysts in OCT images and the is of considerable importance. In this paper, a fast method is proposed to determine the status of OCT images as cystic or non-cystic. The method consists of three phases which are pre-processing, boundary pixel determination and post-processing. After applying a noise reduction method in the pre-processing step, the method finds the pixels which are the boundary pixels of cysts. This process is performed by finding the significant intensity changes in the vertical direction and considering rectangular patches around the candidate pixels. The patches are verified whether or not they contain enough pixels making considerable diagonal intensity changes. Then, a shadow omission method is proposed in the post-processing phase to extract the shadow regions which can be mistakenly considered as cystic areas. Then, the pixels extracted in the previous phase that are near the shadow regions are removed to prevent the production of false positive cases. The performance of the proposed method is evaluated in terms of sensitivity and specificity on real datasets. The experimental results show that the proposed method produces outstanding results from both accuracy and speed points of view.

A large anterior mediastinal mass in a young infant

Abstract Funding Acknowledgements Type of funding sources: None. TITLE A large anterior mediastinal mass in a young infant Case Report A 4 week old male neonate, KS was referred to the emergency department with a 24 hour history of increased work of breathing, two brief episodes of apnoeas and inspiratory stridor. There was no infective symptoms or changes to his usual feeding pattern. There was no significant past medical history and he was on no regular medications. A chest x-ray demonstrated a large mediastinal mass and suspicion of cardiomegaly. A transthoracic echocardiogram demonstrated a structurally and functionally normal heart. However, there was a large anterior homogenous soft tissue mass extending to the left ventricular apex which was separate from the pericardium. This mass did not cause any heart chamber compression or compromise. Further cross-sectional imaging with cardiac computed tomography (CT) showed a non-enhancing uniform soft tissue mass occupying the superior and anterior mediastinum without evidence of calcification or fatty components. The lesion was seen to be extending from the root of the neck down to the left cardiac apex region with the total dimensions of the mass being 5.2 x 3.5 x 5cm. There was no compression of the great arteries or the airway. Parasternal ultrasound of the chest showed a starry sky appearance compatible with normal thymic tissue. Overall, the appearances were felt to be compatible with a prominent normal thymus. Discussion The differential diagnosis of an anterior mediastinal mass in young infants includes germ cell tumours (mainly teratomas), congenital thymic cysts and true thymic hyperplasia(1). These can be difficult to distinguish from the normal large neonatal thymus. The normal thymus can take on a variety of shapes and sizes and still be considered normal. One of the most important features of a normal thymus is the lack of mass effect or compression on the airway or vascular structures(2). True thymic hyperplasia is characterised by an increase in the size and shape of the thymus while preserving thymic architecture. If the anterior mass has a bipyramidal morphology with the presence of gross intercalated fat on CT, these findings are pathognomonic for thymic hyperplasia(3). Thymomas are rare in children and appear as well-defined, rounded or lobulated soft tissue density mass with mild enhancement on CT. It can demonstrate irregular borders with extension into adjacent structures and approximately 30% will have necrosis and internal cystic foci(4). The most common germ cell tumour in the mediastinum is a teratoma with the hallmark being fat, fluid and calcified components on CT(2). Lymphomas are the most common anterior mediastinal mass in children but are usually seen in children older than 5 years. They often cause mass effect with displacement of the trachea. CT scan demonstrates larger nodal areas with hypodense and cystic areas suggestive of necrosis(1). Abstract Figure 1 Abstract Figure 2

Imaging in gynecological disease (23): clinical and ultrasound characteristics of ovarian carcinosarcoma.

To describe the clinical and ultrasound characteristics of ovarian carcinosarcoma. This was a retrospective multicenter study. Patients with a histological diagnosis of ovarian carcinosarcoma, who had undergone preoperative ultrasound examination between 2010 and 2019, were identified from the International Ovarian Tumor Analysis (IOTA) database. Additional patients who were examined outside of the IOTA study were identified from the databases of the participating centers. The masses were described using the terms and definitions of the IOTA group. Additionally, two experienced ultrasound examiners reviewed all available images to identify typical ultrasound features using pattern recognition. Ninety-one patients with ovarian carcinosarcoma who had undergone ultrasound examination were identified, of whom 24 were examined within the IOTA studies and 67 were examined outside of the IOTA studies. Median age at diagnosis was 66 (range, 33-91) years and 84/91 (92.3%) patients were postmenopausal. Most patients (67/91, 73.6%) were symptomatic, with the most common complaint being pain (51/91, 56.0%). Most tumors (67/91, 73.6%) were International Federation of Gynecology and Obstetrics (FIGO) Stage III or IV. Bilateral lesions were observed on ultrasound in 46/91 (50.5%) patients. Ascites was present in 38/91 (41.8%) patients. The median largest tumor diameter was 100 (range, 18-260) mm. All ovarian carcinosarcomas contained solid components, and most were described as solid (66/91, 72.5%) or multilocular-solid (22/91, 24.2%). The median diameter of the largest solid component was 77.5 (range, 11-238) mm. Moderate or rich vascularization was found in 78/91 (85.7%) cases. Retrospective analysis of ultrasound images and videoclips using pattern recognition in 73 cases revealed that all tumors had irregular margins and inhomogeneous echogenicity of the solid components. Forty-seven of 73 (64.4%) masses appeared as a solid tumor with cystic areas. Cooked appearance of the solid tissue was identified in 28/73 (38.4%) tumors. No pathognomonic ultrasound sign of ovarian carcinosarcoma was found. Ovarian carcinosarcomas are usually diagnosed in postmenopausal women and at an advanced stage. The most common ultrasound appearance is a large solid tumor with irregular margins, inhomogeneous echogenicity of the solid tissue and cystic areas. The second most common pattern is a large multilocular-solid mass with inhomogeneous echogenicity of the solid tissue. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Bucillamine in the treatment of patients with mild to moderate COVID-19: an interview with Michael Frank.

Bucillamine in the treatment of patients with mild to moderate COVID-19: an interview with Michael Frank.

Voluminous Solitary Neurofibroma of the Nasosinus Cavities in an Undermedicalized Context: Reflection on a Case Collected in Bamako

Neurofibroma is a benign tumor of the connective tissue developed mainly at the expense of the endoneurium of the peripheral nerves. Histologically, there are two types of neurofibroma: plexiform and solitary. The objective of this work was to report a case of solitary nasosinusal neurofibroma in order to discuss diagnostic and therapeutic difficulties in a developing country. BA aged 17, with no known pathological history, was admitted to the service for a left nasal obstruction which had been evolving for about 4 years. The endonasal examination found a congestive mass, not bleeding on contact, filling the entire left nasal fossa pushing back the nasal septum on the right. Computed tomography showed a heterogeneous dense tissue process with cystic areas, filling the left nasal fossa with extension to the posterior sinuses, left maxilla. The patient was operated under general anesthesia via the left paralateronasal route. The tumor was difficult to cleave but not friable and not bleeding. The histological examination concludes to a neurofibroma. Conclusion: Solitary neurofibromas are uncommon and remain poorly understood. Literature data, rare, do not answer all the questions.

Rare Case report of Sclerosing Stromal Cell Ovarian tumor in adolescent age group

Introduction :Sclerosing stromal cell tumor (SST) is an extremely rare benign ovarian tumor which is a subtype of ovarian stromal tumor of sex cord-stromal origin . So far about 208 cases throughout the world .These tumors occur predominantly in the second and third decade of life. Case report :We report a case of sclerosing stromal cell tumor of ovary in 14 year old girl for its rarity who presented with mass abdomen and menstural irregularity with Inhibin B elevated .CECT abdomen showed features suggestive of left ovarian solid mass lesion with internal clear cystic areas drained by left ovarian and internal iliac veins -possibly malignant mass (?Dysgerminoma).Patient was planned for laprotomy and proceed .Surprisingly histopathological examination revealed Sclerosing stromal tumor of ovary .

Clinical Scenario and Imaging with Illustrations of Giant Cell Tumor of Bone: A Retrospective Analysis.

The giant cell tumour of the bone has a spectrum of clinical-radiological presentation. This study aims to describe this varied presentation in our institution. This retrospective study was conducted on twenty-nine pathologically labelled cases of giant cell tumours of the bone. The medical records for their clinical presentation and diagnostic imaging studies were studied and evaluated. Mean age of the patients at presentation was 35.3±12.9 years. Pain, local swelling and restricted joint function were seen in 93 %, 58.6 % and 52 % patients, respectively. The cortical breach was seen in 15 (51.7 %) and 22 (75.9 %) lesions on plain radiographs and CT images, respectively. 14(48.3 %) cases had soft tissue invasion on MRI at presentation. 26 (89.7 %) lesions were located within 1 cm from the articular cartilage. The solid tumour component was hypo to iso-intense in signal intensity in 27 (93.1 %) lesions in T1 weighted and 21 (72.4 %) in T2 weighted images. 14 (48.3 %) had hyperintense cystic areas, and fluid-fluid levels, suggestive of aneurysmal bone cysts, were seen in 4 (13.8 %) cases on T2 weighted images. Hypo-echoic nodular areas in solid tumour component, suggestive of hemosiderin deposits, were present in 3 (10.3 %) lesions on T1 and T2 weighted images. The tumour classically presents as an epiphysial-metaphyseal, eccentric, expansile, lytic lesion in a skeletally mature patient. The MRI picture is variable and the surgeon should have a sound knowledge of these variations to obtain a biopsy sample from a proper site of the lesion and to avoid misdiagnosis especially of a primary ABC.

Aspectos clínicos, ultrassonográficos e anatomopatológicos do teratoma ovariano em uma novilha

ABSTRACT: Teratomas rarely occur in domestic species, especially in cattle. These tumors originate in fetal life and are characterized by rapid growth, which justifies their frequent detection in young animals. This study reported a case of ovarian teratoma in a heifer. On physical examination, the main signs identified were apathy, abdominal distention and tension, empty rumen, and mushy diarrhea. During rectal palpation, a mass was identified in the pelvic region, which was suggestive of cysts on ultrasound examination. The animal underwent laparotomy, followed by euthanasia due to a poor prognosis. At necropsy, a 54 x 43 x 52 cm (length x width x thickness) tumor was observed in the right ovary with multiple cystic areas, in addition to masses associated with multiple adhesions of the intestinal loops and peritonitis. On histopathology, muscle, cartilage, bone, nervous and epithelial tissue, glands, hair with follicles, were identified in the affected ovary. There was mixed inflammation and foci of necrosis observed with a complete absence of ovarian architecture in both the ovaries. Infiltrations were identified in the lymph nodes and mesenteric vessels. Glandular ducts were seen from the serosa to the intestinal mucosa. A locally infiltrative and expansile ovarian teratoma was diagnosed accordingly. It is considered that this kind of tumor can induce abdominal distension and absence of estrus in previously healthy, non-pregnant heifers.

Pulmonary, liver and cerebral paragonimiasis: An unusual clinical case in Colombia

BackgroundMainly affecting poorer populations in remote (sub)tropical areas, paragonimiasis is considered one of the world's most neglected tropical diseases by the World Health Organization. It is usually acquired by consuming undercooked freshwater crustaceans and primarily affects the lungs, but may ectopically migrate to other organs to produce a multisystemic clinical presentation. This study details what appears to be the first documented case in South America and particularly in Colombia of cerebral paragonimiasis and infection by the crab Moreirocarcinus emarginatus. Case presentationAfter consuming this crab, a 32-year-old Colombian male developed dyspnea and headache. A chest X-ray revealed tension pneumothorax (TPT) and a thoracoscopic lung biopsy bronchiolitis, eosinophilia, and granulomatous reaction due to Paragonimus parasites. ResultsBrain tomography and MRI also showed a configuration typical of Paragonimus parasites, namely a predominantly cystic area near the left cuneus with diffusion restriction, a hemosiderin halo, and linear enhancement characteristic of the tunnel sign, indicating an adult worm moving in the brain. ConclusionsCerebral paragonimiasis can occur in the Colombian population and Moreirocarcinus emarginatus can be its cause. In rural areas, education about raw crab consumption would be beneficial, and physicians addressing lung-related complaints should bear paragonimiasis in mind and ask about raw crab consumption.

A case report on asymptomatic and biochemically silent pheochromocytoma in adrenal incidentaloma

Pheochromocytoma are rare tumours originating from the chromaffin tissue. The clinical manifestations are variable and are not specific as pheochromocytoma and often imitate other diseases. The diagnosis is established by measurement of catecholamines and their metabolites in urine or plasma and by radiographic studies for localisation. Surgical removal of the tumour is the preferred treatment. 45 years old female presented with adrenal incidentaloma of about 6.1×6.2×5.4 cm well defined heterogenous lesion with internal cystic areas seen in right adrenal region abutting upper pole of right kidney. Biochemical investigations for adrenal hormones including plasma aldosterones, cortisols, plasma metanephrines, 24 hrs urinary metanephrines and VMA were found to be normal. Proceeded with adrenelectomy and histopathology of the specimen revealed pheochromocytoma as diagnosis. Pheochromocytoma leads to high mortality and morbidity rates if untreated. Fractionised metanephrines and catecholamines in a 24 hrs urine analysis is the preferred biochemical test. In a biochemically silent pheochromocytoma imaging modalities are used to identify and locate the tumour. Adequete alpha and beta blockade should be ensured before tumour removal. Surgery is recommenced irrespective of size and normal biochemical study to prevent complications.